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Box 944226, Sacramento, CA 94244-2260  \nPhone: (800) 952-5210 Email: [barbercosmo@dca.ca.gov](barbercosmo@dca.ca.gov)  \n[Website:](Website: www.barbercosmo.ca.gov)[ ](Website: www.barbercosmo.ca.gov)[www.barbercosmo.ca.gov](Website: www.barbercosmo.ca.gov)  \n(1004) ESTHETICIAN APPLICATION FOR  \nEXAMINATION AND INITIAL LICENSE FEE* $115.00 (non-refundable)  \n*If you are applying as a spouse or registered domestic partner of an active military member (Section E(5)) or have served as an active duty member and have been honorably discharged from the United States Armed Forces (Section E(6), please check this box  \n| Cashiering\u003Cbr>Use Only:\u003Cbr>1015 |  |  |  |  |  | Entity \\# |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Receipt \\# |  |  |  |  |  |  |  | Amount $ |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| I qualify for the examination as a (See Section D) (choose one):\u003Cbr>California Student Out of State Out of Country |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Previously Licensed |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| SECTION A: APPLICANT INFORMATION Attach a copy of your government-issued photographic identification. NOTE: The name on the identification and the name entered on this application must match to gain admission to the examination. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Social Security Number or Individual Taxpayer Identification Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date ofBirth (must be at least 17 years old) |  |  |  |  |  |  |  |  |\n| |  |  |  |  |  |  |  |  | - | |  | - | |  |  |  |  |  |  |  |  |  | \u003Cbr>-\u003Cbr>\u003Cbr>-\u003Cbr> |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Month Day Year |  |  |  |  |  |  |  |  |\n| Last Name (print clearly) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | First Name |  |  |  |  |  |  |  |  |  | Middle Name |  |  |  |  |\n| Note: Double check your address, and notify the Board of Barbering and Cosmetology (Board) immediately via email at barbercosmo@dca.ca.gov if your address changes. Government mail is not forwarded. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Address (This is the address where your scheduling letter will be mailed) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Apartment \\# (if applicable) |  |  |  |  |  |  |\n| City |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | State | Zip Code |  |  |  |  |  |  |\n| Telephone Number |  |  |  |  |  |  | - | |  |  | | |  |  |  |  |  |  | E-mail Address |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| SECTION B: SCHOOL/GRADUATION INFORMATION (California Students Only)* |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| School Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | School Phone Number |  |  |  |  |  |  |  |  |\n|  | Date you Started Training at this School |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date you Completed Training at this School |  |  |  |  |  |  |  |  |  |  |  | Total Hours Completed\u003Cbr>|  |  |  |\n|  | |  |  | -\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  | |  | -\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Month Day Year |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Month Day Year |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  *Attach your Proof of Training Document(s) (except previously licensed – see sectio","cbCaiaiMyCLNEzI8","https://ap.wps.com/l/cbCaiaiMyCLNEzI8","pdf",1471033,"English","# Applicant Information\n## Applicant identity and contact details\n# School/Graduation Information\n## California students only\n# Exam Information\n## Exam location and language preference\n## Interpreter and reasonable accommodation\n# Qualifications\n## Choose one eligibility category","[{\"question\":\"What documentation must be attached with the esthetician application?\",\"answer\":\"A copy of government-issued photographic identification is required. Interpreter and reasonable accommodation forms must be attached when applicable.\"},{\"question\":\"How are exam language preferences handled?\",\"answer\":\"Select a language preference (e.g., English, Vietnamese, Spanish, Korean). The examinations are translated into neutral versions acceptable to a wide audience.\"},{\"question\":\"Can the practical exam date be changed after scheduling?\",\"answer\":\"No. Once scheduled for the practical portion, the practical exam date cannot be changed. If unable to take it, submit an application for re-examination and pay the required fee.\"}]","Esthetician Application for Examination and Initial License Fee - $115 | PDF",1789288223]